Bipolar TrekUnderstanding Bipolar Disorder2014-12-19T17:56:28Zhttp://blogs.psychcentral.com/bipolar-trek/feed/atom/Dr. Yanni Malliarishttp://www.drmalliaris.comhttp://blogs.psychcentral.com/bipolar-trek/?p=2432014-12-19T17:56:28Z2014-12-19T17:55:58ZLittle is known about the benefits that exercise can offer in patients who are suffering from Bipolar Disorder. Over the past years little research has been conducted and this has been limited. Generally, physical activity has been found to reduce the risk of several diseases and to improve well-being. As for the mental spectrum evidence shows that exercise has significant benefits in unipolar depression (mild to moderate) but the evidence is limited.

National Institute for Health and Clinical Excellence (NICE) suggest’s that ”whilst exercise may be a healthy way of using up the excess energy in a person with mania and a useful distraction, it might further arouse the body physiologically, increasing energy, social contact and self-efficacy, exacerbating manic symptoms and potentially increasing further cardiovascular strain”. Furthermore literature suggests that no published research has directly assessed whether or not physical activity can be harmful to patients with a diagnosis of Bipolar disorder, or how the bipolar symptoms might be moderated by varying exercise intensity.

Literature (Carless & Douglas, 2008; Crone, 2008) on the other hand suggests that exercise can have several potential benefits such as:

A recent study by Kim Wright et al. (2012) examined the issue of physical activity in bipolar patients by exploring their experience using interviews.

In this study the participants were recruited by advertisements in the local community, mental health organisations, and a database of individuals who had previously expressed an interest in partaking in research projects run by the host institution. The participants required to be aged 18 or above, and the mean age of the participants was 51 years old. A total of 26 participants took part in the study.

The diagnosis of the participants was established using the Structured Clinical Interview for DSM-IV. Participants who had been diagnosed with mood independent psychosis were not included in the study.

The investigators used a measure called Seven Day Physical Activity Recall in order to measure the levels of exercise each participant. This research tool also measures the level of intensity of each activity (mild to moderate to vigorous etc). Vigorous activities are those who can leave the person out of breath, while moderate activity include the activities that may increase the heart rate but they do not leave the person breathless.

The investigators also developed a special semi structured interview for this study. This interview contained eight questions asking about the exercise habits of the participants. Two more questions were included in order to enquire about the experience between Bipolar disorder and exercise, and other questions examined the perceived barriers in doing and maintaining an exercise programme. In addition, the interview inquired about recommendations that have been given to the participants from health care professionals. Finally, it examined the potential utility of a short physical exercise intervention on people who suffer from a Bipolar disorder.

The first theme revealed that some participants viewed exercise as a way of managing the changes in their mood. Many even reported that exercise is a useful way to manage the different symptoms of their bipolar disorder. Also participants stated that exercise helped them to extend the euthymic periods of their bipolar disorder, and also reported a reduction in the intensity of the depressive symptoms as well as the hypomanic ones. Some of the participants also reported that their mood would decrease if they did not exercise regularly.

The participants were also asked about the positive and negative impact of exercise on their Bipolar disorder. The majority of the participants discussed the helpful or harmful effects of physical activity when they were manic or hypomanic. Half of the participants reported that any positive effects of physical activity might be diminished if the person experiences severe manic symptoms or depressive ones. For example they reported that even though exercise can bring an initial feeling of calmness, then it can also lead to increases of symptoms of mania. Nevertheless with mild levels of depression many felt that exercise can be helpful.

Finally the majority of the participants proposed that physical activity can provide some sort of structure their chaotic bipolar life. They suggested the following:

• ”Exercise can provide structure to one’s daily routine
• ”Exercise can have an internal structure or an inherent rhythm”

A number of participants found that rhythmic exercise can be of use to people who suffer from Bipolar disorder by :

To conclude, almost over a quarter of the participants did not use physical activity to regulate their symptoms. On the other hand, almost half of the participants reported using exercise regularly to regulate their symptoms. Furthermore, the participants believed the notion that physical activity can have a prophylactic effect against severe mood swings.

The participants also suggested that exercise can bring some structure in the chaotic thoughts and it can support a structured routine. They also reported that exercise can have a calming effect on hypomania. Nevertheless, a minority feared that physical activity can trigger a manic episode. Some of the participants stated that exercise can function both in ascentive and descentive ways, depending on the severity of the mood state.

Lastly, a key theme that emerged from the study was that the physical activity needs to suit the patients’ interests, fitness needs, and energy levels. Many participants stressed the importance of having support for engaging in physical activity especially during depressive episodes, and during periods of high mood that need to be regulated.

We are looking forward to learning about your experiences with exercise and your bipolar disorder.

]]>3Dr. Yanni Malliarishttp://www.drmalliaris.comhttp://blogs.psychcentral.com/bipolar-trek/?p=2372014-03-10T18:50:50Z2014-03-10T18:50:50ZNon-adherence in the treatment of bipolar disorder is a very common phenomenon, which has been addressed by various researchers. The negative consequences may include relapse, hospitalization, impairment in everyday functioning, and it can be costly.

In a recently published pilot study by Wenze, Armey, and Miller (2014), the improvement of treatment adherence in bipolar disorder was tested using Personal Digital Assistants (PDAs). More specifically, the investigators wanted to test whether an intervention that utilized mobile technology and assisted the monitoring of bipolar disorder would be feasible and acceptable by bipolar patients.Fourteen patients, with a diagnosis of bipolar spectrum disorder, participated in the study. The participants completed 2 weeks of brief twice-daily symptom assessments (which included common early warning signs of bipolar disorder, such as mood, mood change, sleep disturbance, psychomotor problems, anxiety, perceptual problems) and other potential momentary risk factors for treatment non-adherence (concordance between appointment attendance and medication adherence). In the beginning and at the end of this 2-week period participants completed measures of manic and depressive symptoms.

Semi-individualized feedback was given back based on the participants’ responses. At the end of the study, participants had also the chance to give additional feedback, and to express their overall satisfaction with the use of the PDA.

The findings of the present study suggested that the sessions were useful for the participants as a means to learn more about their symptoms and to increase treatment adherence. According to the researchers, this particular intervention helped participants to remember their daily appointments and medications, facilitated the conversations about therapeutic relationship with their treatment providers, established a routine into their everyday life, and developed a sense of positivity about their health. Finally, the researchers also found a decrease in the depressive symptoms of the participants.

Do you use a PDA (or smartphone) or any other electronic mood diary to help you monitor your bipolar disorder?

Do you prefer it over a more traditional paper-based mood diary or not?

In our clinical work at BipolarLab, we often come across bipolar patients who seek help when they are depressed. Depression may be the most common symptom, and the most frequent episode of bipolar disorder, but it is not always the most urgent phase to treat. Manic episodes may be more urgent, and more dangerous. Nevertheless, it takes an experienced, and a well trained bipolar patient to seek help once manic. Depressive episodes with increased suicidal ideation or psychotic symptoms can be equally urgent, but for the most common depressive episodes urgency is a matter of choice.

Most of our depressed patients will often ask for immediate relief of their depression. But I always tell them what’s the rush?

Being depressed and impatient may often be dangerous. And I repeat to them…what’s the rush? And they probably wonder what’s wrong with me. Until we start discussing their history, and start to identify previous episodes and other periods of their life where attempts for quick recovery led to hypomanic and manic switches, use and abuse of illegal substances (including antidepressant drugs), frequent changes and erroneous choice of therapists and therapies, and as a result more time with future depressive symptoms and episodes.

The fact is that being in a depressive episode doesn’t really matter much.

One way or another the depressive episode will pass. What will not pass, and what is really important, is the cycling and the constant episodes. By making the depressive episode a treatment priority, one can easily forget what’s really important here. This is also important for mental health professionals to understand. It’s important to stop the episodes and to build stability – not to relieve immediate pain.

The more I treat bipolar depression, the more I appreciate how important it is to take it slowly, and to help my patients recover as gradually and as naturally as possible. Quick recoveries with antidepressant treatments are more likely to destabilize bipolar moods, and to bring ephemeral periods of wellness. Everybody will be extremely happy – but only for a little while.

So what’s the rush I ask again?

And I listen to my wisest expert bipolar patients who cherish their periods of depression. They accept the pain. They cherish their new insights, and the fact that their families find them more cooperative than ever. They cherish their better understanding of their bipolar disorder.

I admire their patience and trust in our treatment approach that relies more on mood stabilizing medications and cognitive behavioral therapy. I admire their trust in our advise to take it slowly in order to achieve a slow (and painful) but stable recovery.

I respect your pain and troubles if you are depressed, but take a moment and ask yourself, what’s the rush?

Reading so many articles about holidays and depression but at the same time working almost exclusively with bipolar patients, I wondered too. Is Christmas good for your Bipolar disorder? What can I really tell you or to our patients about this?

I have no data really from my own research. A pubmed search surprisingly enough brought up only one article/letter by Nick Cradock (a British Psychiatrist from Wales, UK conducting one of the largest genetic studies on Bipolar disorder) dated back in 1992. However, the letter refers to a patient with bipolar disorder and Haemophilia B (a genetic illness also known as Christmas disease, named after the first reported patient, Stephen Christmas)

So even though we seem to have no data to tell you whether Christmas is good or not for your bipolar disorder, I will offer a few thoughts based on what we know from cognitive behavior therapy and bipolar research.

It may all depend how you approach your forthcoming holiday season.

If you have negative expectations about your forthcoming Christmas experience, then you are very much likely to confirm your negative expectations. Cognitive therapy works wonders by helping people to change their negative expectations of future events and negative appraisals of current events. If you did have negative experiences during previous Christmas holidays, and possibly also experienced depressive symptoms or episodes, then you are very much likely to have developed negative schemas about Christmas. Your negative schemas – if left alone – will affect how you will interpret your experiences during Christmas.

From a behavioral point of view, if you start by predicting that you will have a horrible Christmas time, then you are likely to avoid your friends and family members. Or even avoid a little Christmas shopping spree because you don’t have enough money to buy all the things you want or because you are afraid your most recent manic shopping spree. By avoiding pleasurable activities and social contact again you are destined to have a miserable Christmas experience. Behavior therapy has proven itself really effective for treating depression by ensuring that depressed people are once again slowly but gradually being exposed to pleasurable activities. Even if you are alone, you can always make the first step and get in touch with a local support bipolar group. I am sure they will be happy to have you along for Christmas.

And then we have the change in your routines.

As with any holiday season, during Christmas you are likely to experience a change in your usual routines. What we know from interpersonal and social rhythm therapy is that changes in your routine may destabilize your mood and lead to new bipolar episodes. Again, I do not think we have any hard data particularly about Christmas and bipolar episodes, but from the studies and the knowledge we have, if your Christmas holiday leads to major changes in your routines then you may end up having a negative Christmas experience.

So all in all, I would say it all depends about how you will approach, and what you will do during your Christmas.

Even if your previous Christmas experiences may not have been necessarily good ones, it is never too late to fall into the magic of Christmas. Become the Santa of your loved ones (and yourself), and enjoy your time off work and time back with your family. Forget the grudges, forgive past mistakes and quarrels, and move on with the positives in your life. Do so with care of course, and one step at a time. Look after your sleep and watch your alcohol intake.

But engage with whatever positive comes your way, and make up your own Merry Christmas.
This Christmas may be the start for a better and more balanced year or years to come.

Treatment of bipolar disorder includes medication, which aims at mood stabilization, and various forms of psychotherapy (e.g. Family Focused Therapy, Cognitive Behavioral Therapy and Interpersonal and Social Rhythm Therapy). Nevertheless, until recently, these therapies couldn’t deal with the cognitive symptoms of the disorder in patients who were in remission. These symptoms are called residual or subsyndromal and can be equally problematic for some patients.

In a recent study by Deckersbach and colleagues (2010) a new cognitive remediation treatment was developed, which targets residual depressive symptoms, occupational difficulties and overall psychosocial functioning in patients with bipolar disorder.

The investigators measured psychosocial functioning in the domains of work, relationships, recreation and global satisfaction. Occupational functioning was also measured in terms of low performance while at work and missed days of work due to mental health problems. Depressive and manic symptoms were measured using psychometric tests. Finally, neuropsychological functioning, as a predictor of treatment response, was also measured.

The findings of the present study suggested that at the end of cognitive remediation treatment, and at the 3-months follow-up, patients with bipolar disorder exhibited a significant decrease in residual depressive symptoms and an increase in occupational and overall psychosocial functioning.

The study demonstrated once again that Bipolar patients very often face occupational difficulties and problems in their everyday functioning, even when they are not in an episode (manic/depressive).

By decreasing residual depressive symptoms and improving cognitive skills in planning, problem-solving, memory and attention, the cognitive remediation therapy led to improvements in occupational functioning.

Cognitive rehabilitation treatment, which blends established CBT techniques for depression with compensatory cognitive remediation strategies (for improving memory and concentration), has been successfully implemented to individuals with schizophrenia in the past (Medalia & Choi, 2009).

The present study suggested that the same also applies to euthymic bipolar patients. However, further research in the area is needed for this therapy to be established as a complementary therapy for some patients.

These developments in the psychosocial treatment of bipolar disorder help us to advance even further our CBT treatment programs, and allow us to work with patients who would otherwise find it difficult to benefit from traditional CBT therapy.

Do you find it yourself that your symptoms continue even when you are out of an episode?

Bipolar disorder has been found to be “the sixth most disabling medical condition”(Murray & Lopez, 1997). Bipolar patients often have other medical conditions such as obesity, diabetes and heart disease and both depression and mania are phases that are associated with
significant problems in activity.

Therefore, one cannot help but realize the need to look into more depth the complex relationship between physical activity and bipolar disorder.

Even though many studies in the past have tried to look at this relationship, it is only recently that advances in accelerometer technologies are beginning to help us to measure accurately activity patterns in bipolar disorder.

A recent study by Janney and colleagues (2013) used accelerometers that were placed on an elasticized belt over the hip of each participant and objectively measured the duration and intensity of physical activity for one week. Their selected sample of 60 adult outpatients with bipolar disorder was compared with a general sample of mental health service users and non-users. Depressive and manic/hypomanic symptoms were also measured before and after the one-week observation period. Most Bipolar patients were asymptomatic.

The results of the study suggested that adults with bipolar disorder were significantly less active than the compared sample of patients from a broader and less severe spectrum of mental health disorders.

The following were found for patients with bipolar disorder:

78% (13.5 hours per day) of the monitoring time was spent in sedentary (inactive) physical behaviour

21% (215 minutes per day) of the time was spent in light physical activity

1,4% (14 minutes per day) of the time was spent in moderate/vigorous activity

Males engaged in 9 more minutes of moderate/vigorous activity than females.

However, based on the study design, it is not yet possible to establish a causal relationship between lack of physical activity and risk of common medical comorbidities in adults with bipolar disorder. This is something that has to be investigated in future studies.

Moreover, the accelerometer used could not record the type of physical activity performed and if, for example, you were a swimmer or you were only exercising your upper body then the accelerometer wouldn’t be much of a use.

Finally, the participants may not have been representative enough given that the majority were females, middle-aged, and overweight.

Previous work from our lab has highlighted the utility of activity sensors for monitoring symptomatic states in Bipolar disorder, and indeed we find the addition of activity sensors invaluable in our treatment and symptom monitoring programs.

How active would you say you are?

Are you using any of the commercial activity sensors that are readily available to monitor your bipolar disorder?

Bipolar disorder is a serious mental disorder that disrupts the emotional and social lives of people who suffer from it.

Patients with bipolar disorder experience intense periods of mania, where they tend to feel over optimistic or even grandiose, and often become overly social or even inappropriate in their contact with other people. This is something they usually regret and feel ashamed of later, but they have little control over their behavior when they are manic. They also tend to experience periods of depression, where they become withdrawn and isolate themselves. When they do not experience a mood episode, they tend to be fairly well and very likable and cherish the friendship of others, but the effects of their previous episodes persist. The mood episodes disrupt their social lives, and as a result they are often isolated. The lack of a supportive network of friends makes their lives even more difficult to bear, increases their risk to become unwell again, and delays their recovery.

Our BipolarLab eBuddy program aims to develop a network of BipolarLab eBuddies who will volunteer their time to befriend at least one bipolar patient who will be undergoing supervised treatment by a BipolarLab professional.

BipolarLab eBuddies will receive free training and supervision, and will be required to have 1 joint e-activity per week with a bipolar patient for a minimum period of 3 months. The activities may include befriending the patient via social networks (facebook, google+), playing electronic games, talking on the phone, becoming pen pals or any other joint e-activity that will be agreed with the therapist and the bipolar patient. eBuddies may live anywhere in the world, and are required to have an internet connection and speak English or Greek.

BipolarLab eBuddies do not need to have any particular training in mental health. All training, supervision, and ongoing support will be provided at no cost by the supervising therapist.

The program is an excellent opportunity for undergraduate psychology students who may wish to gain some experience with the field of clinical psychology and Bipolar disorder. A certificate of participation and a letter of recommendation will be provided to all volunteers at the end of their participation in the program.

The BipolarLab eBuddy Program is supported by Dr Yanni Malliaris, BSc., PhD who is the leading therapist and principal supervisor of the project.

In order to participate in the program, email BipolarLab (support@bipolarlab.com) a copy of your CV, and a brief (1 page) statement describing who you are, and why you wish to become a BipolarLab eBuddy. You are also welcome to join our Mailing List and our facebook group.

We would be grateful if you share this announcement with your friends and/or post it in your psychology department’s noticeboard/mailing list.

–

BipolarLab.com is a pioneering private clinical practice that delivers specialist clinical services for Bipolar disorder and recurrent depression remotely across the world.

Put the turkey into the marinade and refrigerate for 12 or more hours.

Before stuffing, remove from the water, rinse and dry thoroughly.

To make the filling, sauté the onion and minced meat in olive oil.

Pour the wine or brandy into the pan and then add all the remaining ingredients for the filling.

Allow to simmer until fluids are absorbed.

Remove from the heat and allow cooling.

Stuff the turkey and sew.

Rub on all sides with the butter, stuffing some underneath the skin and then pour the mixture for the baking in.

Put it in the oven at 180 degrees after covering with aluminum foil and bake for about 2 ½ hours.

Open the oven every 15 minutes and drizzle the turkey with pan juices.

In the last 20 minutes remove the foil and let it brown.

Remove from the oven and let rest for at least 15 minutes before carving.

The MoodEat ingredients of Happiness

The turkey contains white meat without much fat and is a good source of protein of high biological value. Most importantly it contains the amino acid tryptophan, an essential building block of serotonin, which regulates mood, quality of sleep and emotional stability.

Also, depending on the diet of turkey, the meat can contain higher or lesser amounts of omega-3 fatty acids, which are shown to improve mood and decrease depression. It is a good source of selenium, zinc and B vitamins which enhance neurological function and mood.

Brown rice that we chose for this recipe is very nutritious because it contains fiber, amino acids and B vitamins associated with euphoria and brain function. Moreover, complex carbohydrates such as potatoes and rice enhance the absorption of tryptophan and thus the action of serotonin in the brain.

Chestnuts are rich in monounsaturated fatty acids such as oleic acid and a good source of omega-3 fatty acids like pine nuts. Furthermore, they both contain many minerals like magnesium which plays a role in contraction and relaxation of muscles.

Chili has the ability to improve mood by stimulating nerves that give a signal to the brain to release chemicals called endorphins. Endorphins have the capacity to reduce feelings of pain and relieve the depressive mood.

Spices like cinnamon and cloves may offer euphoria through taste and smell, but it is also known that when consumed in large quantities they have similar effects to substances associated with feelings of euphoria.

Rosemary is often used in aromatherapy as relaxing. Its therapeutic use relieves stress, relaxes muscles, improves digestion and prevents heartburn and indigestion after a heavy meal. Also, a survey using placebo showed that sage also reduces stress, elevates mood and improves memory.

Finally, black pepper contains compounds called alkaloids. One of these is piperine which simulates pancreatic enzymes that break down proteins, accelerating the process of digestion. Piperine can dramatically increase the absorption of selenium, vitamin B and beta-carotene, and other nutrients. It also helps to increase endorphins in the brain.

A glass of red wine can perfectly accompany this meal and let us relax. However, we should pay attention to overeating and drinking… because the opposite effects are larking.

If you do try this special moodeat recipe at home with your friends and family, why don’t you let us know how you got on with it?

]]>0Dr. Yanni Malliarishttp://www.drmalliaris.comhttp://blogs.psychcentral.com/bipolar-trek/?p=1332012-09-27T08:44:26Z2012-09-26T20:22:38ZSetting up and running an evidence based clinical e-practice in the field of mental health is an exhilarating challenge!

In other fields of medicine, this may not be the case, but in the mental health world, evidence based practice is a relatively new development.

“Evidence-based practice” means we conduct our clinical practice based on evidence that we’ve acquired from clinical research. Similar to drug research, your doctor will usually prescribe medications that’ve been tested thoroughly through many trials, and have been proven to benefit your health condition. Once upon a time, your therapy could’ve been based on Dr. Ego’s clinical expertise, big name or great insights, but thankfully these days such practices are slowly becoming a nightmare of the past (although, drug companies still invest on armies of Dr. Egos “aka opinion leaders” to influence your local doctor’s prescription practices).

However, evidence-based practice is a fairly recent development in the field of mental health, and especially in the field of psychotherapy. The rise of behavioral therapy in the 60s, partly as a reaction to the psychoanalytic status quo, and later its marriage with cognitive therapy, have given us a remarkable new tradition of true evidence-based psychotherapeutic practice.

The development of diagnostic manuals such as the DSM-IV, even though they are heavily criticised by many, have enabled us to quantify severe behavioral and emotional problems. We can now have large enough homogeneous groups of patients that allow us to try out different treatments, and be confident that the improvements we see are not due to chance, individual differences or simply a matter of time. Even when we focus on single patient cases, our diagnostic and measurement methods take this kind of work to a different level.

Clinical trial designs have become sophisticated enough to address almost all biases and errors that a single clinician is prone to make, with one patient or even a small group of patients, over his lifetime.

We now have the tools to quantify almost all clinical states. We can safely measure how depressed, manic, anxious a patient is, and so forth. Of course our tools are far from perfect, but they are improved study after study.

This quantification of human pain and distress, distasteful as it may sound to some, has enabled us to be able to evaluate properly all kinds of therapeutic interventions. Let’s even assume that some genius comes up with the wonderful idea that clapping your hands three times a day and jumping up and down your bed twice a day will cure your bipolar disorder. We can now evaluate and test whether this is true or not.

Nevertheless, despite this tremendous progress in mental health, we find that true evidence-based practice is only delivered through a few specialist university clinics, and only through their research trials. The lucky few patients who can enroll in these studies usually experience significant clinical benefits.

I grew up professionally in such a place, at the Institute of Psychiatry at King’s College London, the mecca of psychiatry. Day after day, trial after trial, that I worked my way up from a lowly research assistant to a PhD graduate, I couldn’t help but wondering why we cannot offer this level of care and quality of clinical work to everybody. My grandiosity, of course, to be able to deliver this level of care to all bipolar patients was fueled by my personal experiences with my father, who suffered for many decades by a treatment resistant bipolar disorder. He also suffered and paid dearly with his health, and later life, the inefficiencies of the greek mental health system. Patients at the time were treated fairly poorly, were not educated about their disorder, and treatment was most of the times coercive.

Hence, when the time was right I founded BipolarLab.com: the first private evidence-based clinical e-practice for bipolar patients in the world.

Of course setting up a true evidence-based e-practice is easier said than done. It took nearly 2 years (7 years including my PhD work) to develop our clinical services that are all based on data driven research, and it will take many more years of clinical work and refinement to achieve all the benefits this endeavour can really deliver.

It also takes patients who can understand and truly appreciate what’s on offer here. Time after time, my colleagues tell me we need to better communicate the novelty of BipolarLab. This is not just another private clinical practice, it’s not even another specialist clinical practice; it’s an evidence-based specialist clinical practice. It may not be the right kind of practice for everybody, but our ongoing evaluation of our services will demonstrate whether this approach is working or not.

It definitely feels great when well funded professors from Harvard approach you with similar ideas, and then you see them working hard to develop similar services, but I will feel much better when we manage to communicate the novelty and importance of this work to every single bipolar patient who visits our website. I will feel even better when we manage to deliver our services to enough patients to have our own effectiveness data.

So how do we do it?

Here is our secret recipe for everybody to copy:

1. We focus on a specific clinical population: Bipolar disorder.

In our case, we deliver our clinical services only to patients with Bipolar disorder and depression. It’s usually hard to separate the two given that most depressive disorders are often highly recurrent, and most bipolar disorders are dominated by depression. Hence, we will consider taking on any patient with a recurrent affective disorder.

2. We use cutting edge research instruments for the diagnosis and measurement of our patients.

We use research instruments like the SCID, HDRS, YMRS, NIMH-LCM and many others to accurately diagnose our patients and measure their status throughout all steps of our clinical care. Our patients also become fairly familiar with these research instruments, and learn to recognise how valuable they are in their ongoing clinical care.

3. We provide our services remotely across the world. We love e-health!

Being an e-practice helps us have a much wider pool of patients to carefully screen and decide whether they are suitable for our evidence-based services (we do have two local sites – one in London, UK and another one in Athens, Greece but we prefer the e-way). We also use many new technologies to help us deliver our services (we love google plus, actigraphy, pedometers, and electronic mood diaries – see MoodChart our recent addition to our e-arsenal – it’s open to the public). We bring our services right into your home, no matter where you live.

4. We use strict inclusion and exclusion criteria.

We provide our services only to bipolar patients who meet our specific inclusion criteria. We derive these criteria from the studies that each of our services has been based upon. It’s painful to exclude patients, but it’s even more painful to deliver services to patients we know aren’t going to benefit from them. Our initial consultation meeting will give us both a fairly good idea about our suitability for each other.

5. We have developed and provide services that are truly evidence-based.

We work hard to follow the protocols and methods of the trials all our services have been based upon. For instance our CBT therapy programme is based on the bipolar trial of Professor Dominic Lam at the Institute of Psychiatry, and is suited to bipolar patients who are currently fairly well (euthymic) or mildly symptomatic, and wish to prevent further relapses. For bipolar patients who are currently depressed, we use the CBT protocol of the STEP-BD trial that gave great results with this group, and also a new briefer behavioral treatment that I’ve been developing for bipolar depression (BATMAN: Behavior Activation Therapy for MANic Depressive illness) over the last few years.

6. We ignore the bipolar fairy tales.

We have developed our services based on the latest knowledge that we have about bipolar disorder – not on bipolar fairy tales. We like the bipolar fairy tales, they make people feel good, but in the long run they are anything but helpful. For instance, since the relapse literature demonstrates that mild bipolar symptoms are the best predictor of relapse, we take special care in explaining this to our patients and provide treatment for them, not more fairy tales about how helpful these symptoms are for their lives. Ignoring the fairy tales often makes us unpopular, and it’s bad for business (see the comments from my previous article) but we’re not a commercial enterprise, and definitely don’t run for the bipolar white house.

7. We collect data and evaluate the effectiveness of all our services.

We do this even more for pioneering clinical services, such as our Bipolar and Fit programme or our behavioral activation therapy for bipolar depression – both relatively new even in the clinical research world. Our symptom monitoring services have been designed to monitor the effectiveness of all our clinical interventions, and most importantly to give our patients a good indication of where they are with their therapy and current mood status.

8. We work as a clinical research group.

All our senior associates, psychologists and psychiatrists, have at least a research PhD that helps them appreciate and value this type of work, and gives them the necessary experience to deliver our evidence-based services properly. Mind you, we are a clinical e-practice of independent clinicians working together – not some major corporation, funded by pharma or guided by commercial interests. We have no association with any drug company!

9. We collaborate with local doctors and other local mental health professionals.

Many of our services have been designed to assist the work of local mental health professionals. For instance, our symptom monitoring programmes provide the most accurate and comprehensive measure of the daily, weekly, and monthly course of any recurrent affective disorder. This can help you and your psychiatrist to better evaluate the progress of your treatment, sometimes clarify your diagnosis, and have an ongoing bipolar thermometer in your life. Our CBT and Life Style Support programmes also work best along with medication treatments. All these are specialist services that can rarely be found locally, and psychiatrists who provide medication treatments don’t have the time, resources or training to offer them. Our small but growing network of local mental health professionals are grateful for the added value our services provide to the treatment of their patients.

10. Last but not least, we love our work, our patients and our results.

We are as maniacally enthusiastic as any clinical research team starting a new project. The glowing results of many clinical trials are always helped by this kind of attitude. We do our best to keep this research spirit alive! In many ways, we’re like the Apple of 1984, having a vision to put evidence-based services in every bipolar home.

We welcome you, whether you are a patient, relative or a mental health professional to join our cause!

One thing that determines our enjoyment in life is mood. Mood changes from day to day, moment to moment. We may be happy, energized, have optimistic feelings, take part in enjoyable activities, feel loving; but we may also feel unpleasant, moody, irritable, anxious, tired and even depressed. We’ve all come across these feelings and have experienced the enormous impact they have on our psychological and physical wellbeing. However, as people tend to favor positivity and happiness, we try to regulate our bad moods by engaging in certain activities and routines such as eating, exercising, smoking, drinking, socializing, playing games, watching TV, etc.

According to research data, from time to time, at least one third of us turn to food when we’re in a bad mood. Think for a moment if this happens to you. When are you most prone to make bad choices, to break the rules of a diet and to choose some kind of “comfort food?”

This actually can happen when we’re happy – for example when we’re socializing and we combine food with nice company. But the time when we are most vulnerable to overeating and bad food choices is when we’re in a bad mood.

“Emotional eating” happens when bad moods are too heavy to carry and a shelter is needed, something that in the past made us feel good. This behavior creates a vicious cycle where we search for a mood fix, get a food fix as an easy solution and momentarily feel ok. However, the drastic changes in blood glucose can cause mood swings; thus, after a while we easily slip into a tired and remorseful mode and the cycle begins once again. Unfortunately, attempts to regulate mood through “emotional eating” are an important cause of being overweight. In the long term, if this cycle isn’t broken we may end up with chronic metabolic diseases.

How food regulates mood

The other side of the coin is that different foods affect our moods. Scientific evidence is very promising in this new direction of research. So, does this mean that that a piece of chocolate can make us smile, or that a cup of tea can pass positive energy to the drinker?

Those foods shown to be the most promising include polyunsaturated fatty acids (PUFAs), vitamins and minerals, phospholipids, and some botanicals. Some are already marketed as herbal medicines and supplements; others as functional foods. Moreover, it is proven that brain chemicals (a.k.a neurotransmitters) such as serotonin, dopamine and acetylcholine that influence the way we think, feel and behave, can be affected by what we’ve eaten.

Foods that have the capacity to influence neurotransmitters are brown rice, sesame seeds, fish, eggs, bananas, spinach and many more. A lot of scientific research has identified that maintaining steady blood glucose by eating small and regular meals throughout the day is the ultimate weapon against mood fluctuations. Generally, keeping food consumption in moderation and making smart choices of ingredients, can guarantee your emotional well being.

Having this evidence in mind, the new trend in gastronomy cannot be perceived as excessively sophisticated. Restaurants around the world are now serving food according to the mood somebody wants to achieve. You can now order food that defies your depressive mood or drink refreshments that make you feel energized. Furthermore, new diet patterns have emerged through the scientific community that can make us happier with our outer and inner selves.

If we want to draw a conclusion about the connection between mood and food, clearly it’s far smarter to regulate your mood through your food rather than letting your mood regulate your food intake.

What’s your experience with your food and mood?

References

Robert E. Thayer. Calm Energy: How People Regulate Mood with Food and Exercise. ISBN-10: 0195131894, 2001.